title: Risk factors and complications associated with difficult retrieval of embolic protection devices in carotid artery stenting.
abstract: OBJECTIVE
  This study was designed to investigate the risk factors and complications of difficult retrieval (DR) of embolic protection devices (EPDs) in carotid artery stenting (CAS).
  
  
  METHODS
  A total of 195 consecutive patients who underwent CAS between December 2007 and March 2010 in a general hospital were enrolled and divided into two groups: with DR and without DR. The risk factors of DR were analyzed with univariate and multivariate analyses. The complications of DR were recorded and analyzed.
  
  
  RESULTS
  A total of 30 (15.4%) patients with DR of EPDs were observed, of whom EPDs were successfully retrieved in 29, and in 1 was it taken out by surgical treatment. The retrieval time was significantly longer in patients with DR (490.5 ± 143.9 s) than in patients without DR (157.2 ± 15.7 s, p = 0.000). Vasospasm was observed more frequently in patients with DR than in patients without DR (55.2% vs. 14.5%, p = 0.000). Intracranial compilations were more frequent in patients with DR than in those without DR (17.2% vs. 0.6%, p = 0.000). Calcified plaques, degree of residual stenosis, types of the stents, and tortuosity index (TI > 80°) were all associated with DR. A logistic regression analysis indicated that calcified plaques (odds ratio (OR) = 6.5; p = 0.000) and TI > 80° (OR = 18.8; p = 0.000) were independent predictors of DR.
  
  
  CONCLUSIONS
  Calcified plaques and TI > 80° may be related to DR in patients with CAS. DR may lengthen the retrieving time and increase the complications of the procedure.
authors.affiliation: Department of Neurology, Jinling Hospital, Second Military Medical University, 305# East Zhongshan Road, Nanjing 210002, China.
authors.forename: Xuegan
authors.initials: X
authors.lastname: Lian
authors.forename: Wenhua
authors.initials: W
authors.lastname: Liu
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Min
authors.initials: M
authors.lastname: Lin
authors.forename: Shuanggen
authors.initials: S
authors.lastname: Zhu
authors.forename: Wen
authors.initials: W
authors.lastname: Sun
authors.forename: Qin
authors.initials: Q
authors.lastname: Yin
authors.forename: Gelin
authors.initials: G
authors.lastname: Xu
authors.forename: Renliang
authors.initials: R
authors.lastname: Zhang
authors.forename: Xinfeng
authors.initials: X
authors.lastname: Liu
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D016009:Chi-Square Distribution; D020878:Device Removal / Q000009:adverse effects; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D012042:Registries; D012307:Risk Factors; D015607:Stents; D014057:Tomography, X-Ray Computed
chemical_list: D010975:Platelet Aggregation Inhibitors